Cardio Notes: Coumadin Home Testing Viable

Patients on warfarin (Coumadin) who used a self-testing device were able to maintain a high rate of time in target range, a retrospective analysis of the STABLE study found.

Of the nearly 30,000 patients analyzed, the rate of time in target range for those who self-tested weekly was 73%, while the overall rate, which included variable testing, was 69%, according to Jack Ansell, MD, from Lenox Hill Hospital in New York City.

Compared with younger patients (46 to 64 years), older patients (65 to 74 years) had higher a rate of time in target range (67% versus 72%), Ansell reported at the recent American College of Cardiology meeting.

Comparative times in target range from recent large trials evaluating the new oral anticoagulants have included:

Ansell said that home monitoring achieves better outcomes because it's convenient for patients, the test is consistent, and the immediate awareness of test results empowers patients and enhances compliance.

Three-quarters of the patients in the STABLE study were on warfarin for nonvalvular atrial fibrillation, and these patients had better rates in therapeutic range compared with patients with other indications such as valvular disease alone or with atrial fibrillation and venous thromboembolism. Men had a slight edge over women in percent time in target range (72% versus 66%).

Safe Transition to Transradial PCI Program

Establishing a program at teaching hospitals for routine use of the transradial approach for percutaneous coronary intervention (PCI) carries no safety risks, researchers found.

During the first year of the transradial program, no major vascular or bleeding complications occurred in 194 consecutive patients, reported Robert A. Leonardi, MD, and colleagues from the Medical University of South Carolina in Charleston.

In fact, the combined bleeding and complication rates were lower in the year of the transradial program's inauguration (0.7% versus 2%, P=0.05), according to the study published online in the American Journal of Cardiology.

The transradial program was carried out by 9 different attending cardiologists and 13 cardiology fellows. None of the physicians had routinely used the transradial approach before the start of the program. However, researchers said that none of the problems encountered with the transradial approach were the result of the learning curve.

"As physicians, we are obligated to practice medicine in a manner that minimizes morbidity and mortality for our patients. As cardiologists, we have the opportunity to do so by learning and teaching transradial techniques for coronary angiography and intervention," they concluded.

SPECT Images Vulnerable Plaque

Scientists have created radiolabeled nanobodies that zero in on unstable plaque components that can be seen with SPECT imaging.

Catheter-based imaging modalities, such as optical coherence tomography and intravascular ultrasound, have helped researchers better understand the mechanisms of vulnerable plaque. But these invasive imaging techniques could not be used for routine testing of those at risk.

So Alexis Broisat, PhD, from the University of Grenoble, France, and colleagues capitalized on prior research and created nanobodies -- one-tenth the size of antibodies and with faster pharmacokinetics -- that bonded in the lab and in mice to vascular cell adhesion molecule-1 (VCAM-1). VCAM-1 is involved in hypercholesterolemia and other pro-inflammatory environments associated with atherosclerosis, they reported online in Circulation Research.

The investigators labeled the nanobodies with technetium-99m and used SPECT imaging to visualize their attraction to VCAM-1 expressing tissue in the aortic arteries of mice.

Other imaging modalities such as PET, ultrasound, and MRI can also image nanobodies. In addition, in this study, SPECT identified human and mouse cross-reactive labeled VCAM-1, making these nanobodies "ideal for clinical translation," researchers said.

Afib Often Recurs After Ablation

Catheter ablation of atrial fibrillation centered on pulmonary vein isolation is more palliative than a true cure, researchers said.

Of 103 patients with drug refractory atrial fibrillation, two-thirds had recurrence in the first year after ablation, reported Antonio Sorgente, MD, from Beth Israel Deaconess Medical Center in Boston, and colleagues.

Of those who had more than one ablation procedure, the only predictor of recurrence after multivariate analysis was nonparoxysmal atrial fibrillation (P=0.02), according to the study published online in the American Journal of Cardiology.

Although there were no significant predictors of recurrence after a single procedure, trends were present for Afib duration, body mass index (BMI), nonparoxysmal Afib, and left atrial size.

Sorgente and colleagues defined recurrence as atrial arrhythmia lasting more than 10 seconds. The mean age of patients was 53, mean BMI was 29 kg/m2, and more than three-quarters were men. Follow up was for 6 years.

They called for the creation of an atrial fibrillation clinic, "which represents an integrated approach to the management of AF."

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